Provider Demographics
NPI:1598862468
Name:SAMARITAN PODIATRY GROUP INC.
Entity Type:Organization
Organization Name:SAMARITAN PODIATRY GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:WARNE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:408-358-1833
Mailing Address - Street 1:PO BOX 320838
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-0113
Mailing Address - Country:US
Mailing Address - Phone:408-358-1833
Mailing Address - Fax:408-356-5753
Practice Address - Street 1:2577 SAMARITAN DR STE 750
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4109
Practice Address - Country:US
Practice Address - Phone:408-358-1833
Practice Address - Fax:408-356-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3687213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC725AMedicare PIN
CAU42343Medicare UPIN
CAZZZ75982ZMedicare PIN